MEDICARE: RECOVERY DYNAMICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1407661713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY DYNAMICS LLC

Provider Business Mailing Address
First Line	:	1776 N HIGHLAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	948 S COCHRAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4739
Country	:	US
Telephone Number	:	213-333-3869
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	MR. REZA FARAZMAND
Credential	:
Telephone Number	:	310-266-7484

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	12/08/2025

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